From the Guidelines
No, you should not treat asymptomatic bacteriuria in most adults. Asymptomatic bacteriuria, which is the presence of bacteria in the urine without symptoms of urinary tract infection, generally does not require antibiotic treatment in non-pregnant adults. The only populations who should receive treatment for asymptomatic bacteriuria are pregnant women and patients undergoing urologic procedures where mucosal bleeding is anticipated. For pregnant women, treatment typically involves antibiotics such as nitrofurantoin 100mg twice daily for 5-7 days, amoxicillin-clavulanate 500mg three times daily for 3-7 days, or cephalexin 500mg four times daily for 3-7 days. Treating asymptomatic bacteriuria in other adults does not reduce complications and may lead to unnecessary antibiotic exposure, which can cause side effects, promote antibiotic resistance, and disrupt the normal microbiome. The bacteria present in asymptomatic bacteriuria often represent colonization rather than infection, and the immune system can typically manage this colonization without intervention.
Key Points
- Asymptomatic bacteriuria is common in adults and does not typically require treatment in non-pregnant individuals.
- Treatment is recommended for pregnant women and patients undergoing urologic procedures with anticipated mucosal bleeding.
- Antibiotic treatment for asymptomatic bacteriuria in other adults can lead to unnecessary antibiotic exposure and promote resistance.
- The immune system can manage asymptomatic bacteriuria without intervention in most cases.
Evidence
The recommendation against treating asymptomatic bacteriuria in most adults is supported by guidelines from the US Preventive Services Task Force 1 and the Infectious Diseases Society of America 1. More recent guidelines from the European Association of Urology 1 and the American Urological Association 1 also support this recommendation. These guidelines emphasize the importance of avoiding unnecessary antibiotic use to prevent resistance and promote appropriate management of asymptomatic bacteriuria.
From the Research
Asymptomatic Bacteriuria Treatment in Adults
- Asymptomatic bacteriuria is a common clinical condition that often leads to unnecessary treatment 2
- The incidence of asymptomatic bacteriuria increases with age and is more prominent in women than men, with older women in long-term care facilities having an incidence of up to 50% 2
- In most scenarios, asymptomatic bacteriuria does not lead to urinary tract infections, and antibiotic treatment has not been shown to improve patient outcomes 2, 3, 4
Guidelines for Treatment
- The Infectious Disease Society of America (IDSA) updated its asymptomatic bacteriuria management guidelines in 2019, emphasizing the risks and benefits of treating the condition 2
- Women who are pregnant should be screened for asymptomatic bacteriuria in the first trimester and treated if positive 2, 5, 4, 6
- Individuals undergoing endoscopic urologic procedures should be screened and treated appropriately for asymptomatic bacteriuria 2, 6
- Treatment of asymptomatic bacteriuria in individuals with diabetes, neutropenia, spinal cord injuries, indwelling urinary catheters, and other conditions has not been found to improve clinical outcomes 2, 4, 6
Consequences of Unnecessary Treatment
- Unnecessary treatment of asymptomatic bacteriuria is often associated with unwanted consequences, including increased antimicrobial resistance, Clostridioides difficile infection, and increased healthcare costs 2, 3, 4
- Multiple antibiotic stewardship programs have implemented protocols to reduce unnecessary treatment of asymptomatic bacteriuria 2
- It is essential to appropriately screen and treat asymptomatic bacteriuria only when there is evidence of potential benefit 2, 5, 3, 4